Chirurgia最新文献

{"title":"Axillary Lymph Node Dissection versus Loco-regional Radiotherapy in Management of the Axilla in Node-Negative Locally Advanced Breast Cancer Post Neoadjuvant Chemotherapy.","authors":"Amr Kamaledin Ebrahim, Omar Lasheen, Sherif Mokhtar, Shaimaa Lasheen, Mohamed Hassan, Emad Khallaf","doi":"10.21614/chirurgia.3006","DOIUrl":"10.21614/chirurgia.3006","url":null,"abstract":"<p><p><b>Background:</b> the evolution of axillary management in breast cancer has witnessed significant changes in recent decades, leading to an overall reduction in surgical interventions. There have been notable shifts in practice, aiming to minimize morbidity while maintaining oncologic outcomes and accurate staging for newly diagnosed breast cancer patients. These advancements have been facilitated by the improved efficacy of adjuvant therapies. Objective: To compare the outcomes of axillary lymph node dissection (ALND) and loco-regional axillary radiotherapy (ART) on lymphedema and disease recurrence in locally advanced breast cancer (LABC) cases that have shown a downstaging of their axillary status after neoadjuvant chemotherapy (NACT). Material and <b>Methods:</b> sixty patients with LABC with an initial cN1-2 disease showed a downstaging of their axillary status to cN0 after NACT. They were randomized into two groups. The first group (the control group) underwent ALND, while the second group (the study group) had a sentinel lymph node biopsy (SLNB) and post-operative ART. Patients with failed SLNB or positive SLNB were excluded. All patients were followed up for loco-regional recurrence and lymphedema for at least one year. <b>Results:</b> no statistical significance was found between both groups regarding loco-regional recurrence. There was a higher rate of arm lymphedema in the control group. Lymphedema was found in 46.7% of patients who underwent ALND, compared to 13.4% in the study group (patients with SLNB and radiotherapy). Conclusion: axillary radiation after SNLB has shown no difference regarding axillary recurrence when compared to ALND. However, our results were in favor of radiation concerning lymphedema. With all the ongoing research aiming at reducing axillary surgery, this study could be an initiative for a new strategy in LABC.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 6","pages":"676-686"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Lymphatic Drainage Through Sentinel Lymph Node Biopsy in Cutaneous Melanoma Using a Radioactive Tracer - Technetium-99m (99mTc).","authors":"Răzvan Ioan Andrei, Silviu Cristian Voinea, Aniela Nodiţi, Teodora-Mihaela Peleaşă, Mirela Gherghe, Alexandru Blidaru","doi":"10.21614/chirurgia.3077","DOIUrl":"https://doi.org/10.21614/chirurgia.3077","url":null,"abstract":"<p><p><b>Background:</b> cutaneous melanoma has often unpredictable lymphatic drainage patterns, especially at the level of the trunk, head and neck regions. Sentinel lymph node biopsy (SLNB) is an important prognostic tool that accurately assesses regional lymph node involvement and guides therapeutic decisions. Material and <b>Methods:</b> this prospective study involved 104 patients diagnosed with cutaneous melanoma who underwent SLNB using a radioactive tracer. Sentinel lymph nodes (SLN) were identified via lymphoscintigraphy and gamma camera guidance, followed by histopathological and immunohistochemical evaluation. <b>Results:</b> the SLNB identification rate was 100%. Multiple lymphatic drainage basins (LDB) were identified in 27% of cases, predominantly in trunk, head, and neck regions. The mean number of SLN identified was 2.11 by lymphoscintigraphy and 3.35 by histopathology. SLN metastases were present in 22.11% of patients. <b>Conclusions:</b> SLNB with a radioactive tracer is particularly useful for cutaneous melanomas of the trunk, head or neck. This technique also has less false negative results for melanomas located at the lever of the limbs.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 6","pages":"666-675"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical vs. Manual Anastomosis in Colorectal Cancer Surgery: A Comparative Analysis.","authors":"Silviu Stefan Marginean, Adrian Radu Petru, Dragos Garofil, Vlad Paic, Razvan Daniel Chivu, Dan Cartu, Anca Tigora, Mihai Zurzu, Mircea Bratucu, Raluca Gabriela Ioan, Florian Popa, Traean Burcos, Valeriu Surlin, Victor Strambu, Irina Ruxandra Strambu","doi":"10.21614/chirurgia.3073","DOIUrl":"https://doi.org/10.21614/chirurgia.3073","url":null,"abstract":"<p><p><b>Background:</b> colorectal cancer is a common and serious condition, with surgical resection being the primary treatment for localized cases. Anastomotic dehiscence (AD) remains a significant postoperative complication, and anastomoses are typically created using either manual suturing or mechanical stapling, each with specific benefits and challenge. Material and <b>Methods:</b> this retrospective study analyzed outcomes in 100 rectal cancer patients who underwent surgical resection, with anastomoses performed via manual suturing (n=50) or mechanical stapling (n=50). Primary outcomes included fistula rates, postoperative complications, and recovery metrics. Secondary outcomes focused on operative time, hospital stay and quality of life. <b>Results:</b> mechanical anastomosis reduced procedure time (15 +- 5 minutes vs. 30 +- 5 minutes; p 0.01) and improved quality of life at 12 months (HQI: 87 vs. 75; p 0.01). The incidence of fistulas was higher in patients with manual suturing compared to mechanical suturing, but without significant differences (12% vs. 22%; p = 0.29). Mechanical anastomosis shortened the hospitalization period (12.66 vs. 13.58 days; but manual suturing allowed for faster recovery of intestinal transit (82% vs. 76%). <b>Conclusions:</b> mechanical anastomosis is more efficient, but manual anastomosis remains valuable in complex cases. Technique selection should be tailored to individual patient needs and surgical conditions.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 6","pages":"611-625"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Caustic Stenosis to Esophageal Cancer, a Challenging Evolution - Narrative Review.","authors":"Dragos Predescu, Florin Achim, Silviu Constantinoiu, Alex-Claudiu Moraru, Alexandru Rotariu, Cristian Gelu Rosianu, Dragos-Viorel Scripcariu, Adrian Constantin","doi":"10.21614/chirurgia.3050","DOIUrl":"https://doi.org/10.21614/chirurgia.3050","url":null,"abstract":"<p><p>Caustic ingestion remains a complex public health problem worldwide, both in adults and children. The consequences of caustic ingestion depend on the severity of the injuries, the general condition of the patient at presentation and the promptness of medical management. Long-term complications include strictures or stenoses, resulting in dysphagia. In addition to metabolic and hydroelectrolytic disorders, consequences of dysphagia, there are distant cases of esophageal cancer based on esophageal stenosis. The ingestion of caustic products is a risk factor for the occurrence of esophageal cancer, and the specialized literature reports the occurrence of the disease, approximately 30 to 40 years after the accident, with the determination mainly of squamous carcinoma. The pathophysiological mechanism of esophageal cancer related to caustic ingestion is not fully understood. The diagnosis of esophageal cancer on post caustic scar is based on two important pillars: the change of the clinic by the appearance or change of the characters of dysphagia and the endoscopic examination of the lesion. Obviously, the information needs to be completed by complex imaging explorations, both for the certification of the diagnosis and for the purpose of a complete oncological assessment. The principles and methods of treatment for \"esophageal scar cancer\" are the same as for any other esophageal cancer: early detection, complete oncological assessment and surgical resection associated with oncological therapy are the main pillars for cure. Due to the complexity of these cases, a series of discussions and recommendations appear as necessary in their management.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 5","pages":"515-532"},"PeriodicalIF":0.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elective Laparoscopic Sigmoidectomy Reduces IL-6 Serum Levels in Uncomplicated Recurrent Diverticulitis.","authors":"Giulio Mari, Richard Sassun, Simone Ciciriello, Francesca Roufael, Dario Maggioni, Gaia Santambrogio, Roberto Delpini, Eugenio Cocozza, Pietro Calcagno, Giovanni Ferrari, Giorgia Rodda, Antonino Spinelli, Marko Markovic, Andrea Costanzi, Giacomo Calini, Siracusa Claudia, Dominici Roberto, Leoni Valerio, Roberto Cirocchi, Fingerhut Abe","doi":"10.21614/chirurgia.3047","DOIUrl":"10.21614/chirurgia.3047","url":null,"abstract":"<p><strong>Introduction: </strong>Although recurrent diverticulitis appears to be a chronic relapsing disease from a clinical standpoint, there are no sufficient data about inflammatory markers that allow monitoring recurrent diverticulitis in the quiescent phase. Our hypothesis is that serum inflammatory markers may be increased during clinical quiescent phases of diverticulitis and will drop after elective laparoscopic sigmoidectomy for uncomplicated recurrent diverticulitis. We also believe that a drop in IL-6 levels across surgery could be related to an improved quality of life.</p><p><strong>Material and methods: </strong>This epidemiological study aims to evaluate IL-6 serum levels and quality of life preoperatively and 6 months after surgery in 30 patients undergoing elective laparoscopic sigmoidectomy for uncomplicated recurrent diverticulitis.</p><p><strong>Results: </strong>The mean preoperative IL-6 level was 9.5 +- 9.2 pg/ml (range 0-5), while at six months after surgery the mean IL-6 was 4.5 +- 3.5. (p=0.0085). Preoperative QoL measured with the GIQLI questionnaire was 98 +- 11.3 and raised significantly after surgery to 112 +- 9.8 (p=0.043).</p><p><strong>Conclusions: </strong>We found a serum IL-6 reduction after elective laparoscopic sigmoidectomy that can be attributed to the surgical removal of the source of inflammation in patients suffering from uncomplicated recurrent diverticulitis. Similarly, the GIQLI questionnaire showed a significantly improved QoL after surgery.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 5","pages":"559-564"},"PeriodicalIF":0.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Age on the Outcomes Following High Ligation and Stripping for Lower Extremity Venous Insufficiency: A Cohort Study.","authors":"Mihaela Pundiche, Nicoleta Leopa, Dragos Bajan, Iulia Cindea, Diana Iosif, Anca Chisoi, Răzvan Cătălin Popescu","doi":"10.21614/chirurgia.3048","DOIUrl":"https://doi.org/10.21614/chirurgia.3048","url":null,"abstract":"<p><p><b>Background:</b> Varicose veins represent a pathology with a frequent number of cases that require surgical treatment. High saphenous ligation and stripping is still a feasible surgical intervention in selected cases. The present study aims to identify age as a prognostic factor after high saphenous ligation and stripping. Material and <b>Methods:</b> The cases of patients admitted between 2016 and 2023 with varicose disease for which high ligation and stripping were performed were prospectively analyzed. 167 patients met the inclusion and exclusion criteria, being divided into two groups: Group I 114 patients under 60 years of age and Group II 53 patients over 60 years of age. Patients were followed in the postoperative period at 1 month and 6 months, respectively, and data were collected using several questionnaires: CEAP, VAS, VCSS and AVVQ. <b>Results:</b> Class 4, according to the CEAP classification, was the most frequently involved regardless of age category (Group I: 49.12%, Group II: 49.06%), followed by class 2 (Group I: 41.22%, Group II: 35.85%). In the preoperative period there were statistically significant differences between the two groups regarding VAS (p = 0.041) and AVVQ (Group I: 12.51 +- 6.11, Group II: 11.11 +- 7.19, p = 0.036). There were no significant statistical differences between the two groups (p = 0.744) regarding the preoperative VCSS questionnaire. At 6 months after surgery, the improvement in VCSS and AVVQ was independent of age. <b>Conclusions:</b> The surgical intervention of high ligation and stripping of the saphenous vein is a safe and feasible operation that can be performed in selected cases and is not influenced by the age of the patients.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 5","pages":"565-571"},"PeriodicalIF":0.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sternal Metastasis from Serous Ovarian Carcinoma - A Narrative Review Highlighting the Importance of Multidisciplinary Management in These Cases.","authors":"Corina Florica Ioniţă, Iulia Ioana Cojocaru, Mihai Cojocaru, Cosmin Nicolescu, Tibor Mezei, Vlad Vunvulea, Corina Mărginean, Ovidiu Aurelian Budişcă, Călin Molnar, Bogdan Andrei Suciu","doi":"10.21614/chirurgia.2978","DOIUrl":"10.21614/chirurgia.2978","url":null,"abstract":"<p><p><b>Introduction:</b> Sternal metastases of serous ovarian carcinoma are extremely rare conditions, with less than 10 articles published in the medical literature on this subject. The aim of this article is to present a case of late-onset sternal metastasis of serous ovarian carcinoma in a patient who underwent surgery for serous ovarian carcinoma approximately 6 years before and to provide a review of the literature regarding the importance of multidisciplinary management in such cases. Material and Method: We aimed to conduct a review of the specialized literature concerning published articles on sternal metastases from ovarian serous carcinoma over a period of approximately 30 years, from January 1, 1994, to December 31, 2023. For this purpose, we utilized the following databases: PubMed and Web of Science (Clarivate Analytics), using the keywords: sternal metastases, ovarian cancer. <b>Results:</b> Following our review of the specialized literature, we identified only 10 articles that reported clinical cases of sternal metastases occurring after ovarian cancer surgery and chemotherapy. Additionally, we present the case of a 70-year-old female patient diagnosed with sternal metastasis from ovarian serous carcinoma, with an emphasis on the therapeutic management of the case. <b>Conclusions:</b> Sternal metastases of serous ovarian carcinoma represent extremely rare conditions. In such cases, if sternal metastases are solitary, and the patient does not present metastases at other sites nor signs of local recurrence, sternum resection may constitute a viable therapeutic option in the treatment of these patients.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 5","pages":"533-542"},"PeriodicalIF":0.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Do a US-guided Preoperative Planning to Choose the Proper Location for Mastectomy Incision (with video).","authors":"Anna Scarabosio, Maximilian Mahrhofer, Laurenz Weitgasser, Thomas Scholler, Pier Camillo Parodi, Glenda Giorgia Caputo","doi":"10.21614/chirurgia.2960","DOIUrl":"https://doi.org/10.21614/chirurgia.2960","url":null,"abstract":"<p><p>video width=\"640\" height=\"480\" controls controlsList=\"nodownload\" poster=\"https://www.revistachirurgia.ro/pdfs/video/anna_scarabosio_vascular_mapping.jpg\" style=\"margin-top: -20px;\" source src=\"https://www.revistachirurgia.ro/pdfs/video/anna_scarabosio_vascular_mapping.mp4\" type=\"video/mp4\" Your browser does not support the video tag. /video Mastectomy remains a prevalent procedure in oncologic surgery, driven by the high incidence of breast cancer and the crucial role of surgical intervention. Over the last two decades, mastectomy techniques have significantly evolved, with conservative approaches such as skin-sparing and nipple-sparing mastectomies gaining widespread adoption. This shift aligns with patients' contemporary demands for improved aesthetic outcomes and quality of life. Concurrently, reconstructive techniques, particularly the pre-pectoral approach, have advanced, focusing on reducing complications like cutaneous necrosis while optimizing cosmetic results. Our study emphasizes the importance of preoperative vascular mapping using Ultrasound Doppler to identify key blood vessels supplying the breast skin and nipple. This technique allows for precise incision placement, preserving vital vessels and minimizing the risk of necrosis. The results demonstrate that US-guided preoperative mapping is a cost-effective method that enhances surgical outcomes and patient satisfaction in breast reconstruction following mastectomy.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 5","pages":"594-597"},"PeriodicalIF":0.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polymorphisms of CD44 rs187115 as a Predictive Biomarker in Early Colorectal Cancer Diagnostic.","authors":"Raluca Dumache, Alexandra Mihailescu, Dana Liana David, Flavius-Lucian Herlo, Gabriel Verdeş, Dan Brebu, Ionuţ Faur, Vlad Braicu, Amadeus Dobrescu, Ciprian Duţă","doi":"10.21614/chirurgia.3007","DOIUrl":"https://doi.org/10.21614/chirurgia.3007","url":null,"abstract":"<p><p><b>Introduction:</b> Colorectal cancer (CRC) has exhibited an increasing incidence worldwide in recent years, underscoring the importance of early diagnosis methods. This study aimed to assess the influence of CD44 gene polymorphism rs187115 on CRC susceptibility. Material and <b>Methods:</b> The study encompassed 470 CRC patients and 165 healthy controls. Genotyping of all biological blood samples was conducted using the TaqMan assay on the ABI 7500 Real Time PCR System (Applied Biosystems, USA). <b>Results:</b> The genotyping revealed that carriers of the variant G allele, including the genotypes AG and GG, exhibited a heightened risk of CRC occurrence, with an odds ratio (OR) of 1.89 (95% confidence interval [CI] = 1.57-1.97; p = 0.047) compared to those carrying the AA genotype. <b>Conclusions:</b> The findings underscore the potential utility of CD44 rs187115 polymorphisms as a novel predictive biomarker for CRC prognosis.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 5","pages":"554-558"},"PeriodicalIF":0.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Rolling Stones: A Systematic Review and Meta-Analysis of the Management of Gallstone Ileus.","authors":"Deelan Vadher, Adele Zacken, Viraj Shah, Mohamad Silmi, Luis Stephen Aguilar, Kejal Patel, Murtuza Aliasgar Calcuttawala, Poyyamozhi Rajagopal","doi":"10.21614/chirurgia.3046","DOIUrl":"10.21614/chirurgia.3046","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Gallstone ileus is a rare but potentially life-threatening condition resulting from the migration of gallstones into the gastrointestinal tract, which often necessitates surgical intervention. Three surgical procedures are well known and are practiced in clinical medicine; they include entero-lithotomy alone, entero-lithotomy with cholecystectomy, and enterolithotomy with fistula closure. However, there is no consensus regarding the best surgical approach as far as mortality, morbidity, and operative outcomes are concerned. The objectives of this systematic review and meta-analysis are to assess the relative efficacy and safety of these surgical procedures. \u0000&lt;b&gt;Methods:&lt;/b&gt; A Preferred Reporting for Systematic Reviews and Meta-Analyses-compliant systematic literature review was conducted following the year 2000. Ovid MEDLINE, Embase and PubMed databases were searched using key terms gallstone, ileus, cholecystenteric fistula, cholecystocolonic fistula to identify cases. Two authors independently checked each study against the inclusion and exclusion criteria at each stage of screening and extraction. After applying the inclusion and exclusion criteria and quality assessment of the Newcastle Ottawa Scale (NOS), 10 studies involving 293 participants were included in the analysis. The quality of included studies was \"moderate to high\" according to the selection, comparability, and outcome criteria. Mortality and morbidity were analysed using pooled odds ratios (ORs) in the randomeffects model and fixed-effects model, and operative time using mean differences (MDs). In addition, subgroup analysis was conducted according to the type of intervention, and heterogeneity was evaluated by I &lt;sup&gt;2&lt;/sup&gt; and π&lt;sup&gt;2&lt;/sup&gt;. \u0000&lt;b&gt;Results:&lt;/b&gt; The meta-analysis showed a significant reduction in mortality with combined enterolithotomy and cholecystectomy (OR: 2.39 [95% CI: 1.87, 3.04], I² = 33%), compared to enterolithotomy alone (OR: 3.09 [95% CI: 1.36, 7.02], I² = 69%). Morbidity was also higher in the fistula repair group (OR: 4.92 [95% CI: 3.38, 7.14], I² = 0%). Operative time was significantly longer for combined procedures, with a mean difference of 62.47 minutes [95% CI: 60.14, 64.81], in contrast to enterolithotomy alone. Subgroup differences were statistically significant, with p 0.01 for both mortality and operative time. Conclusion: This meta-analysis indicates that the combined approach of enterolithotomy and cholecystectomy has a reasonable risk benefit ratio in terms of decreasing mortality and controlling operative difficulty as compared to enterolithotomy alone or enterolithotomy with fistula repair. However, it is worth noting that the procedures that are considered as combined are characterised by longer operative time. These results provide evidence for the decisionmaking process surrounding intervention by taking into account individual features such as the presence of diseases or risks during surgery. These findings ","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 5","pages":"483-514"},"PeriodicalIF":0.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}